胃神经内分泌癌的临床病理特征及预后分析

  目的  探讨胃神经内分泌癌（gastric neuroendocrine carcinoma，G-NEC）、胃混合性腺-神经内分泌癌（gastric mixed adenoendocrine carcinoma，G-MANEC）的临床病理特征及预后因素。  方法  回顾性收集2015年5月至2023年5月于长治医学院附属和平医院就诊并行手术治疗的67例G-NEC、G-MANEC患者的临床资料，并分析其病理特征。  结果  与胃腺癌相比，G-NEC、G-MANEC患者好发于男性的贲门部、确诊时年龄更大、肿瘤直径更大、术前更易发生贫血、低白蛋白、更易侵犯神经和脉管、肿瘤浸润深度更深、淋巴结转移数更多、TNM分期更晚、术后更易发生远处转移。G-NEC、G-MANEC患者的预后较胃腺癌差（P=0.001），而G-NEC和G-MANEC在病理特征（P>0.05）及预后分析（P=0.212）差异均无统计学意义。单因素生存分析显示：年龄、术前白蛋白、术前CEA、淋巴结转移数、TNM分期和术后远处转移是影响患者总生存期（overall survival，OS）的危险因素；多因素分析显示：年龄、术前白蛋白、TNM分期和术后远处转移是影响OS的独立危险因素。  结论  G-NEC、G-MANEC与胃腺癌的临床特征存在显著性差异，且确诊时多处于进展期，术后易发生远处转移。年龄>60岁、术前白蛋白<40 g/L、TNM分期Ⅱ/Ⅲ期、术后发生远处转移的患者预后较差。

Gastroenteropancreatic neuroendocrine neoplasms: ESMO Clinical Practice Guidelines for diagnosis,treatment and follow-up

  Objective  To explore the clinical and pathological characteristics and prognostic factors of gastric neuroendocrine carcinoma（G-NEC）and gastric mixed adenoendocrine carcinoma（G-MANEC）.  Methods  Retrospective analysis was conducted on the clinical data of 67 patients with G-NEC and G-MANEC who underwent surgical treatment at Heping Hospital Affiliated to Changzhi Medical College from May 2015 to May 2023. The study included an analysis of the pathological characteristics distinguishing G-NEC from G-MANEC.   Results  Compared to gastric adenocarcinoma, patients with G-NEC and G-MANEC in the stomach showed a higher incidence of gastric cancer in the male gastric cardia and were diagnosed at a later age. Tumors with larger diameters increase susceptibility to anemia, low albumin levels, and invasion of nerves and vasculature. Deeper tumor infiltration is associated with increased local lymph node metastases, later TNM staging, and a higher likelihood of distant metastasis post-surgery. The prognosis of G-NEC and G-MANEC is worse than that of gastric adenocarcinoma (P=0.001). However, there is no statistically significant difference in the pathological characteristics (P>0.05) and prognosis analysis (P=0.212) between G-NEC and G-MANEC. Univariate survival analysis identified age, preoperative albumin, preoperative CEA, number of lymph node metastases, TNM staging, and postoperative distant metastasis as risk factors affecting patient’s overall survival (OS). In the multivariate analysis, age, preoperative albumin, TNM staging, and postoperative distant metastasiswere identified as independent risk factors for OS.   Conclusions  There is a significant difference in clinical characteristics between G-NEC, G-MANEC, and gastric adenocarcinoma, often diagnosed at an advanced stage, which is prone to distant metastasis post-surgery. Poor prognosis is observed in patients aged over 60 years, with preoperative albumin<40g/L, TNM stage Ⅱ/Ⅲ, and postoperative distant metastasis.